EP3413877A1 - Formulation orale de cholestyramine et utilisation associée - Google Patents

Formulation orale de cholestyramine et utilisation associée

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Publication number
EP3413877A1
EP3413877A1 EP17705974.8A EP17705974A EP3413877A1 EP 3413877 A1 EP3413877 A1 EP 3413877A1 EP 17705974 A EP17705974 A EP 17705974A EP 3413877 A1 EP3413877 A1 EP 3413877A1
Authority
EP
European Patent Office
Prior art keywords
cholestyramine
formulation
formulation according
pellets
colon
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP17705974.8A
Other languages
German (de)
English (en)
Other versions
EP3413877B1 (fr
Inventor
Per-Göran Gillberg
Nils Ove Gustafsson
Nils-Olof Lindberg
Jessica Elversson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Albireo AB
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Albireo AB
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Publication date
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Publication of EP3413877A1 publication Critical patent/EP3413877A1/fr
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Publication of EP3413877B1 publication Critical patent/EP3413877B1/fr
Active legal-status Critical Current
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605—Excipients; Inactive ingredients
    • A61K9/1629—Organic macromolecular compounds
    • A61K9/1652—Polysaccharides, e.g. alginate, cellulose derivatives; Cyclodextrin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/554—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having at least one nitrogen and one sulfur as ring hetero atoms, e.g. clothiapine, diltiazem
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/74—Synthetic polymeric materials
    • A61K31/745—Polymers of hydrocarbons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/74—Synthetic polymeric materials
    • A61K31/785—Polymers containing nitrogen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605—Excipients; Inactive ingredients
    • A61K9/1629—Organic macromolecular compounds
    • A61K9/1635—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone, poly(meth)acrylates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
    • A61K9/5005—Wall or coating material
    • A61K9/5021—Organic macromolecular compounds
    • A61K9/5026—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone, poly(meth)acrylates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
    • A61K9/5005—Wall or coating material
    • A61K9/5021—Organic macromolecular compounds
    • A61K9/5036—Polysaccharides, e.g. gums, alginate; Cyclodextrin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/12—Antidiarrhoeals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/18—Drugs for disorders of the alimentary tract or the digestive system for pancreatic disorders, e.g. pancreatic enzymes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the invention relates to an oral formulation for targeted delivery of cholestyramine to the colon, comprising a plurality of cholestyramine pellets that are coated with a colon release coating.
  • the invention also relates to the use of this formulation in the treatment of bile acid malabsorption.
  • Bile acid malabsorption is a condition characterized by an excess of bile acids in the colon, often leading to chronic diarrhoea.
  • Bile acids are steroid acids that are synthesized and conjugated in the liver. From the liver, they are excreted through the biliary tree into the small intestine where they participate in the solubilisation and absorption of dietary lipids and fat-soluble vitamins. When they reach the ileum, bile acids are reabsorbed into the portal circulation and returned to the liver. A small proportion of the secreted bile acids is not reabsorbed in the ileum and reaches the colon.
  • bacterial action results in deconjugation and dehydroxylation of the bile acids, producing the secondary bile acids deoxycholate and lithocholate.
  • bile acid malabsorption may be divided into Type 1, Type 2 and Type 3 BAM.
  • Diarrhoea may also be the result of high concentrations of bile acid in the large intestine following treatment with drugs that increase the production of bile acids and/or influence the reabsorption of bile acids by the small intestine, such as treatment with ileal bile acid absorption (IBAT) inhibitors.
  • IBAT ileal bile acid absorption
  • the current treatment of bile acid malabsorption aims at binding excess bile acids in the
  • cholestyramine is commonly used as the bile acid sequestrant.
  • Cholestyramine (or colestyramine; CAS Number 11041-12-6) is a strongly basic anion- exchange resin that is practically insoluble in water and is not absorbed from the gastrointestinal tract. Instead, it absorbs and combines with the bile acids in the intestine to form an insoluble complex. The complex that is formed upon binding of the bile acids to the resin is excreted in the faeces.
  • the resin thereby prevents the normal reabsorption of bile acids through the enterohepatic circulation, leading to an increased conversion of cholesterol to bile acids to replace those removed from reabsorption. This conversion lowers plasma cholesterol concentrations, mainly by lowering of the low-density lipoprotein (LDL)-cholesterol.
  • LDL low-density lipoprotein
  • Cholestyramine is also used as hypolipidaemic agents in the treatment of hypercholesterolemia, type II hyperlipoproteinaemia and in type 2 diabetes mellitus. It is furthermore used for the relief of diarrhoea associated with ileal resection, Crohn ' s disease, vagotomy, diabetic vagal neuropathy and radiation, as well as for the treatment of pruritus in patients with cholestasis.
  • the oral cholestyramine dose is 12 to 24 g daily, administered as a single dose or in up to 4 divided doses. In the treatment of pruritus, doses of 4 to 8 g are usually sufficient. Cholestyramine may be introduced gradually over 3 to 4 weeks to minimize the gastrointestinal effects. The most common side-effect is constipation, while other gastrointestinal side-effects are bloating, abdominal discomfort and pain, heartburn, flatulence and nausea/vomiting. There is an increased risk for gallstones due to increased cholesterol concentration in bile.
  • cholestyramine Another drawback with the current treatment using cholestyramine is that this agent reduces the absorption of other drugs administered concomitantly, such as oestrogens, thiazide diuretics, digoxin and related alkaloids, loperamide, phenylbutazone, barbiturates, thyroid hormones, warfarin and some antibiotics. It is therefore recommended that other drugs should be taken at least 1 hour before or 4 to 6 hours after the administration of cholestyramine. Dose adjustments of
  • cholestyramine could be formulated as a colon release formulation, i.e. for release of the cholestyramine in the proximal part of the colon.
  • a colon release formulation i.e. for release of the cholestyramine in the proximal part of the colon.
  • Such a formulation may require a lower dose of cholestyramine and should have better properties regarding texture and taste, and may therefore be better tolerated by the patients.
  • colonic release of cholestyramine should be devoid of producing interactions with other drugs and should not induce risks for malabsorption of fat and fat-soluble vitamins, while still binding bile acids in order to reduce the increased colonic secretion and motility.
  • the number of pills to be taken could be kept as low as possible. Each pill should therefore contain as much cholestyramine as possible.
  • EP 1273307 discloses preparations for preventing bile acid diarrhoea, comprising a bile acid adsorbent coated with a polymer so as to allow the release of the bile acid adsorbent around an area from the lower part of the small intestine to the cecum. It is shown that cholestyramine granules coated with HPMCAS-HF or ethyl cellulose displayed extensive swelling and bursting under conditions simulating the gastric environment. Jacobsen et al. (Br. Med. J. 1985, vol. 290, p.
  • FIG. 1 shows the sequestration profiles for different formulations in an assay simulating the pH of the stomach and the small intestine.
  • FIG. 1A shows the results for formulations A, B and C during 6 hours at pH 5.5.
  • FIG. IB shows the results for formulations A and C during 2 hours at pH 1 followed by 4 hours at pH 6.8.
  • FIG. 1C shows the results for formulation C during 2 hours at pH 1 followed by 4 hours at pH 7.4.
  • FIG. 2 shows the relative concentration of cholic acid (%) vs. incubation time (h) for formulations A, B and C in an in vitro SHIME ® assay. The results for a comparative experiment using pure
  • FIG. 3 shows the relative concentration of chenodeoxycholic acid (%) vs. incubation time (h) for formulations A, B and C in an in vitro SHIME ® assay. The results for a comparative experiment using pure cholestyramine powder and a control experiment without cholestyramine are also shown.
  • FIG. 4 shows the relative concentration of deoxycholic acid (%) vs. incubation time (h) for formulations A, B and C in an in vitro SHIME ® assay. The results for a comparative experiment using pure cholestyramine powder and a control experiment without cholestyramine are also shown.
  • the invention relates to an oral formulation for targeted delivery of cholestyramine to the colon, comprising:
  • more than 75% of the cholestyramine is released in the colon, such as more than 80%, or such as more than 85%. More preferably, more than 90% of the cholestyramine is released in the colon.
  • the invention relates to an oral formulation for targeted delivery of
  • cholestyramine to the colon comprising:
  • less than 30% of the cholestyramine is released in the small intestine.
  • less than 25% of the cholestyramine is released in the small intestine, such as less than 20%, or such as less than 15%. More preferably, less than 10% of the cholestyramine is released in the small intestine.
  • the cholestyramine content of the pellets should be as high as possible.
  • the uncoated pellets therefore preferably contain at least 70% w/w cholestyramine, more preferably at least 75% w/w cholestyramine, more preferably at least 80% w/w cholestyramine, even more preferably at least 85% w/w cholestyramine and most preferably at least 90% w/w cholestyramine.
  • the invention relates to an oral formulation for targeted delivery of
  • cholestyramine to the colon comprising:
  • iii a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer; or
  • more than 70% of the cholestyramine is released in the colon, preferably more than 75%, such as more than 80%, or such as more than 85%. More preferably, more than 90% of the cholestyramine is released in the colon.
  • less than 30% of the cholestyramine is released in the small intestine, preferably less than 25%, such as less than 20%, or such as less than 15%. More preferably, less than 10% of the cholestyramine is released in the small intestine.
  • the presence of specific amounts of a vinylpyrrolidone-based polymer, or of a combination of a vinylpyrrolidone-based polymer and an acrylate copolymer, in the composition of the pellets allows for a high cholestyramine content.
  • the resulting pellets are stable enough to withstand the conditions necessary for applying the coating layer onto the pellets.
  • the colon release coating substantially prevents release of cholestyramine from the pellets until they reach the large intestine, in particular the proximal colon. Additionally, the coating prevents the pellets from bursting. When water that diffuses through the coating is absorbed by the
  • the increasing volume of the cholestyramine leads to swelling of the pellets.
  • the coating of the pellets is elastic and is therefore able to withstand the swelling of the pellets. The coating thereby prevents burst of the pellets and premature release of the cholestyramine.
  • cholestyramine Because of its very low solubility, cholestyramine is not "released” from the formulation in that it dissolves from the formulation and diffuses into the intestine. Instead, the cholestyramine probably stays within the gradually degrading structure of the coated pellet. Therefore, as used herein, the term "release" of the cholestyramine refers to the availability of the cholestyramine to the intestinal content in order to bind components (i.e., bile acids) therein. Pellets
  • pellets refers to extruded pellets, i.e. pellets obtained through extrusion and spheronization.
  • the preparation of extruded pellets typically comprises the steps of mixing a powder with a liquid to obtain a wet mass, extruding the wet mass, spheronizing the extrudate and drying of the wet pellets.
  • the stability of the pellets may be expressed in terms of friability, which is the ability of a solid substance (such as a tablet, granule, sphere or pellet) to be reduced to smaller pieces, e.g. by abrasion, breakage or deformation.
  • friability is defined as the reduction in the mass of the pellets occurring when the pellets are subjected to mechanical strain, such as tumbling, vibration, fluidization, etc. Methods for measuring friability are known in the art (e.g., European Pharmacopoeia 8.0, tests 2.9.7 or 2.9.41).
  • the vinylpyrrolidone-based polymer in the pellets may be polyvinylpyrrolidone (povidone) or a vinylpyrrolidone-vinyl acetate copolymer (copovidone).
  • Povidone is a linear, water-soluble polymer made from N-vinylpyrrolidone.
  • Copovidone also known as copolyvidone
  • the vinylpyrrolidone-based polymer is copovidone.
  • the acrylate copolymer in the pellets may be any pharmaceutically acceptable copolymer comprising acrylate monomers.
  • acrylate monomers include, but are not limited to, acrylate (acrylic acid), methyl acrylate, ethyl acrylate, methacrylic acid (methacrylate), methyl methacrylate, butyl methacrylate, trimethylammonioethyl methacrylate and dimethylaminoethyl methacrylate.
  • acrylate copolymers are known under the trade name Eudragit ® .
  • Poly(ethyl acrylate-co-methyl methacrylate-co-trimethylammonioethyl methacrylate chloride) is a copolymer of ethyl acrylate, methyl methacrylate and a low content of trimethylammonioethyl methacrylate chloride (a methacrylic acid ester with quaternary ammonium groups).
  • the copolymer is also referred to as ammonio methacrylate copolymer. It is insoluble but the presence of the ammonium salts groups makes the copolymer permeable.
  • the copolymer is available as a 1:2:0.2 mixture (Type A) or as a 1:2:0.1 mixture (Type B).
  • 30% aqueous dispersions of Type A and Type B are sold under the trade names Eudragit ® L 30 D and Eudragit ® RS 30 D, respectively.
  • Poly(methyl acrylate-co-methyl methacrylate-co-methacrylic acid) 7:3:1 is a copolymer of methyl acrylate, methyl methacrylate and methacrylic acid. It is insoluble in acidic media but dissolves by salt formation above pH 7.0.
  • a 30% aqueous dispersion is sold under the trade name Eudragit ® FS 30 D.
  • Poly(methacrylic acid-co-ethyl acrylate) 1:1 is a copolymer of ethyl acrylate and methacrylic acid. It is insoluble in acidic media below a pH of 5.5 but dissolves above this pH by salt formation. A 30% aqueous dispersion is sold under the trade name Eudragit ® L 30 D-55.
  • Suitable acrylate copolymers include poly(ethyl acrylate-co-methyl methacrylate) 2:1, which is a water-insoluble copolymer of ethyl acrylate and methyl methacrylate. 30% aqueous dispersions are sold under the trade names Eudragit ® NE 30 D and Eudragit ® NM 30 D.
  • Preferred acrylate copolymers are ammonio methacrylate copolymer, poly(methyl acrylate-co- methyl methacrylate-co-methacrylic acid) 7:3:1, and poly(methacrylic acid-co-ethyl acrylate) 1:1.
  • the acrylate polymer is ammonio methacrylate copolymer, and most preferably the acrylate polymer is poly(ethyl acrylate-co-methyl methacrylate-co-trimethylammonioethyl methacrylate chloride) 1:2:0.2.
  • the pellets comprise cholestyramine and
  • the pellets comprise cholestyramine and
  • the pellets may further comprise an excipient such as microcrystalline cellulose.
  • the pellets comprise from 0 to 20% w/w microcrystalline cellulose, such as from 0 to 10% w/w microcrystalline cellulose. In a more preferred embodiment, the pellets comprise from 0 to 5% w/w microcrystalline cellulose.
  • the pellets are free from microcrystalline cellulose.
  • the pellets comprise from 70 to 92% w/w cholestyramine, from 6 to 12% w/w of a vinylpyrrolidone-based polymer, from 2 to 5% w/w of an acrylate copolymer and from 0 to 20% w/w microcrystalline cellulose. More preferably, the pellets comprise from 80 to 92% w/w cholestyramine, from 6 to 12% w/w of a vinylpyrrolidone-based polymer, from 2 to 5% w/w of an acrylate copolymer and from 0 to 5% w/w microcrystalline cellulose.
  • the pellets comprise from 70 to 92% w/w cholestyramine, from 6 to 12% w/w copovidone, from 2 to 5% w/w ammonio methacrylate copolymer and from 0 to 20% w/w microcrystalline cellulose. More preferably, the pellets comprise from 80 to 92% w/w
  • the pellets comprise from 70 to 93% w/w cholestyramine, from 7 to 12% w/w of a vinylpyrrolidone-based polymer and from 0 to 20% w/w microcrystalline cellulose. More preferably, the pellets comprise from 70 to 93% w/w cholestyramine, from 7 to 12% w/w copovidone and from 0 to 20% w/w microcrystalline cellulose.
  • the pellets comprise from 80 to 93% w/w cholestyramine, from 7 to 12% w/w of a vinylpyrrolidone-based polymer and from 0 to 10% w/w microcrystalline cellulose. More preferably, the pellets comprise from 80 to 93% w/w cholestyramine, from 7 to 12% w/w copovidone and from 0 to 10% w/w microcrystalline cellulose.
  • the uncoated pellets rapidly disintegrate under aqueous conditions. However, they are stable enough to withstand the conditions necessary for applying the colon release coating onto the pellets. Colon release coating
  • the colon release coating around the pellets allows for enzyme controlled release of the
  • the coating comprises a biodegradable polymer that is degraded by bacterial enzymes present in the colon, but that is not degraded by the human enzymes present in the gastrointestinal tract.
  • the release of the cholestyramine from the pellets is thus triggered by changes in the bacterial environment and substantially prevented until the coated pellets reach the colon.
  • the biodegradable polymer may be an azo polymer or a polysaccharide.
  • bacterially degradable polysaccharides include chitosan, pectin, guar gum, dextran, inulin, starch and amylose, as well as derivatives thereof (Sinha and Kumria, Eur. J. Pharm. Sci. 2003, vol. 18, p. 3-18).
  • the colon release coating preferably comprises starch.
  • the structure of starch generally comprises 20-30% (w/w) amylose, which is less easily degraded by intestinal microbiota, and 70-80% (w/w) amylopectin, which is more easily degraded by intestinal microbiota.
  • Resistant starch has a high amylose content and generally escapes from digestion in the small intestine. Such starch is instead digested by bacteria in the colon.
  • resistant starch can be categorized into four types (RSI to RS4), each having different properties.
  • Resistant starch type 2 such as in high amylose maize starch (or high amylose corn starch) is less accessible to enzymes due to the conformation of the starch.
  • the colon release coating around the cholestyramine pellets preferably comprises resistant starch type 2 ( S2).
  • the colon release coating comprises one or more further organic polymers.
  • suitable organic polymers include, but are not limited to, poly(methyl acrylate-co-methyl methacrylate-co-methacrylic acid) 7:3:1 (Eudragit ® FS 30 D), poly(ethyl acrylate- co-methyl methacrylate-co-trimethylammonioethyl methacrylate chloride) 1:2:0.2 (Eudragit ® RL 30 D), poly(ethyl acrylate-co-methyl methacrylate-co-trimethylammonioethyl methacrylate chloride) 1:2:0.1 (Eudragit ® RS 30 D), poly(ethyl acrylate-co-methyl methacrylate) 2: 1 (Eudragit ® NE 30 D or Eudragit ® NM 30 D) and polyvinyl acetate) (e.g., Kollicoat ® SR 30 D).
  • the exemplary organic polymers include, but are not limited to, poly
  • the colon release coating is elastic (i.e., has high elongation at break). Because of the elasticity of the coating, the coating is able to withstand this swelling. Burst of the pellets and premature release of the cholestyramine is thereby avoided.
  • the elasticity of the coating may be the result of the elasticity of the organic polymer(s) itself, or may be induced by the addition of a plasticizer.
  • plasticizers include, but are not limited to, triethyl citrate, glyceryl triacetate, tributyl citrate, diethyl phthalate, acetyl tributyl citrate, dibutyl phthalate and dibutyl sebacate.
  • the colon release coating may comprise one or more further additives, such as acids and bases, glidants, and surfactants.
  • suitable acids include organic acids such as citric acid, acetic acid, trifluoroacetic acid, propionic acid, succinic acid, glycolic acid, lactic acid, malic acid, tartaric acid, ascorbic acid, pamoic acid, maleic acid, hydroxymaleic acid, phenylacetic acid, glutamic acid, benzoic acid, salicylic acid, mesylsc acid, esylic acid, besylic acid, sulfaniiic acid, 2-acetoxybenzoic acid, fumaric acid, toluenesulfonic acid, methartesulfonic acid, ethane disuifonic acid and oxalic acid, and inorganic acids such as hydrochloric acid, hydrobromic acid, sulphuric acid, sulfamic acid, phosphoric acid and nitric acid.
  • organic acids such as citric acid, acetic acid, trifluoroacetic acid, propionic acid, succinic acid, glycolic acid,
  • Suitable bases include inorganic bases such as sodium bicarbonate, sodium hydroxide and ammonium hydroxide.
  • suitable glidants include talc, glyceryl monostearate, oleic acid, medium chain triglycerides and colloidal silicon dioxide.
  • suitable surfactants include sodium dodecyl sulfate, polysorbate 80 and sorbitan monooleate.
  • a barrier coating may optionally be present as an additional layer between the pellets and the coating layer.
  • a barrier coating may also be present when two different coating layers should be kept physically separated from each other.
  • a particularly suitable material for the barrier coating is hydroxypropyl methylcellulose (HPMC).
  • a thin layer of a non-sticking agent may ultimately be applied to the coated pellets. This outer layer prevents the coated pellets from sticking together, e.g. during storage.
  • suitable non- sticking agents include fumed silica, talc and magnesium stearate.
  • the colon release coating substantially prevents release of the cholestyramine from the pellets until they have reached the large intestine.
  • there should be no exposure of the cholestyramine in the small intestine whereas the exposure should be quick once the multiparticulates have passed the ileocecal valve.
  • less than 30% of the cholestyramine is released in the small intestine, such as less than 20%, such as less than 10%.
  • less than 5% of the cholestyramine is released in the small intestine.
  • more than 70% of the cholestyramine is released in the colon, such as more than 80%, such as more than 90%.
  • more than 95% of the cholestyramine is released in the colon.
  • the colon release coating adds further weight and volume to the pellets.
  • the coating layer should therefore be as thin as possible.
  • the amount of coating in the final formulation is less than 45% w/w, more preferably less than 40% w/w and even more preferably less than 35% w/w.
  • the cholestyramine content of the pellets should be as high as possible.
  • the uncoated pellets therefore preferably contain at least 70% w/w cholestyramine, more preferably at least 75% w/w cholestyramine, more preferably at least 80% w/w cholestyramine, even more preferably at least 85% w/w cholestyramine and most preferably at least 90% w/w cholestyramine.
  • the cholestyramine content of the final formulation (on dry weight basis) is preferably at least 50% w/w, and more preferably at least 55% w/w.
  • the size of the pellets is initially governed by the diameter of the screen used in the extrusion step.
  • the pellets may be sieved to obtain a pellet fraction with a narrow size distribution.
  • the diameter of the uncoated cholestyramine pellets is preferably from 500 ⁇ to 3000 ⁇ , more preferably from 750 ⁇ to 2000 ⁇ and even more preferably from 1000 to 1600 ⁇ . In a most preferred embodiment, the diameter of the pellets is from 1000 to 1400 ⁇ .
  • the cholestyramine pellets may be prepared in a process comprising the steps of:
  • the dried pellets may thereafter be sieved in order to obtain pellets of uniform size.
  • the dry ingredients in step i) comprise cholestyramine and the vinylpyrrolidone-based polymer, and may optionally comprise microcrystalline cellulose. Because of its physical nature, cholestyramine powder is able to absorb large amounts of water, which results in considerable swelling of the material. In order to prepare a wet mass from dry cholestyramine, it is therefore necessary to add more water than normally would be used for preparing a wet mass from dry ingredients.
  • water is added to the mix of dry ingredients in an amount of at least 1.5 times the amount of cholestyramine (w/w), more preferably in an amount of at least 1.75 times the amount of cholestyramine (w/w), and even more preferably in an amount of at least 2 times the amount of cholestyramine (w/w).
  • the coating may be applied onto the cholestyramine pellets by methods known in the art, such as by film coating involving perforated pans and fluidized beds.
  • the oral formulation described herein may be administered to a patient in different forms, depending on factors such as the age and general physical condition of the patient.
  • the formulation may be administered in the form of one or more capsules wherein the coated pellets are contained.
  • Such capsules conventionally comprise a degradable material, such as gelatin, hydroxypropyl methylcellulose (HPMC), pullulan or starch, which easily disintegrates under the acidic conditions in the stomach. The coated pellets are thereby quickly released into the stomach.
  • the invention relates to a capsule comprising the oral formulation disclosed herein.
  • the coated pellets may be administered as a sprinkle formulation, the contents of which can be dispersed in liquid or soft food.
  • a sprinkle formulation comprising the oral formulation disclosed herein.
  • the coated pellets may be contained within a capsule, sachet or stick pack.
  • the oral formulation disclosed herein provides several advantages over other formulations.
  • the small coated pellets (multiparticulates) according to the present invention are able to easily pass the gastrointestinal tract. This eliminates the risk that the formulation is temporarily held up in the gastrointestinal tract, such as at the stomach or at the ileocecal valve, as is sometimes encountered with monolithic formulations (such as tablets or capsules that do not disintegrate in the stomach).
  • the cholestyramine is made available to the intestinal content only when the coating starts being degraded as a result of the bacteria present in, and the higher pH at, the lower gastrointestinal tract, in particular the colon. The contents of the stomach and the small intestine are therefore effectively protected from the cholestyramine, which is a major improvement over formulations that directly release the cholestyramine in the stomach or the small intestine.
  • the low solubility of cholestyramine in aqueous environment prevents the release of cholestyramine from the formulation to be measured directly.
  • the availability of the cholestyramine to the intestinal content over time and at different pH values can instead be determined in vitro, such as by measuring the sequestering capacity of the formulation under simulated conditions for the gastrointestinal tract.
  • Such a method involves measuring the decreasing amount of free bile acid (i.e., the compound to be sequestered) in a liquid medium representative of the gastrointestinal tract, as described in the experimental section. See also the Official Monograph for cholestyramine resin (USP 40, page 3404).
  • the invention relates to the formulation disclosed herein for use in the treatment or prevention of bile acid malabsorption.
  • the invention also relates to the use of the formulation disclosed herein in the manufacture of a medicament for the treatment or prevention of bile acid malabsorption.
  • the invention further relates to a method for the treatment or prevention of bile acid malabsorption comprising administering to a mammal in need of such treatment or prevention a therapeutically effective amount of the formulation disclosed herein.
  • Bile acid malabsorption may be divided into three different types, dependent on the cause of the failure of the distal ileum to absorb bile acids.
  • Type 1 BAM is the result of (terminal) ileal disease (such as Crohn's disease) or (terminal) ileal resection or bypass.
  • Type 2 BAM is often referred to as idiopathic bile acid malabsorption or primary bile acid diarrhoea (BAD) and is believed to be the result of an overproduction of bile acids or caused by a defective feedback inhibition of hepatic bile acid synthesis. This feedback regulation is mediated by the ileal hormone fibroblast growth factor 19 (FGF19) in man.
  • FGF19 fibroblast growth factor 19
  • type 3 BAM may be the result of cholecystectomy, vagotomy, small intestinal bacterial overgrowth (SIBO), coeliac disease, pancreatic insufficiency (chronic pancreatitis, cystic fibrosis), pancreatic transplant, radiation enteritis, collagenous colitis, microscopic colitis, lymphocytic colitis, ulcerative colitis or irritable bowel syndrome (i.e., diarrhoea-predominant irritable bowel syndrome (IBS-D)).
  • SIBO small intestinal bacterial overgrowth
  • coeliac disease pancreatic insufficiency
  • pancreatic insufficiency chronic pancreatitis, cystic fibrosis
  • pancreatic transplant radiation enteritis, collagenous colitis, microscopic colitis, lymphocytic colitis, ulcerative colitis or irritable bowel syndrome (i.e., diarrhoea-predominant irritable bowel syndrome (IBS-D)
  • the formulation may also be used in combination with an Ileal Bile Acid Absorption (IBAT) inhibitor.
  • IBAT inhibitors such as in the treatment of liver diseases, disorders of fatty acid metabolism or glucose utilization disorders, may result in increased levels of bile acids and/or influence the reabsorption of bile acids by the small intestine, leading to high concentrations of bile acid in the large intestine and thus causing diarrhoea.
  • This side effect of the treatment with IBAT inhibitors may be treated or prevented by treatment with the formulation as disclosed herein.
  • the formulation and the IBAT inhibitor may be administered simultaneously, sequentially or separately.
  • the invention relates to the formulation disclosed herein, for use in the treatment or prevention of diarrhoea upon oral administration of an IBAT inhibitor.
  • the invention also relates to the use of the formulation disclosed herein in the manufacture of a medicament for the treatment or prevention of diarrhoea upon oral administration of an IBAT inhibitor.
  • the invention further relates to a method for the treatment or prevention of diarrhoea upon oral administration of an IBAT inhibitor, comprising administering to a mammal in need of such treatment or prevention therapeutically effective amounts of an IBAT inhibitor and of the formulation disclosed herein.
  • the invention relates to the formulation disclosed herein, for use in the treatment or prevention of bile acid diarrhoea upon treatment of a liver disease, such as a cholestatic liver disease, comprising oral administration of an IBAT inhibitor.
  • the invention relates to the formulation disclosed herein for use in the treatment or prevention of diarrhoea upon treatment of Alagilles syndrome (ALGS), progressive familial intrahepatic cholestasis (PFIC), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, cholestatic pruritus, non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) comprising oral administration of an IBAT inhibitor.
  • AGS Alagilles syndrome
  • PFIC progressive familial intrahepatic cholestasis
  • PBC primary biliary cirrhosis
  • PSC primary sclerosing cholangitis
  • autoimmune hepatitis cholestatic pruritus
  • NAFLD non-alcoholic fatty liver disease
  • NASH non-alcoholic steatohepatitis
  • the invention in another embodiment, relates to a method for the treatment or prevention of bile acid diarrhoea upon treatment of a liver disease comprising oral administration of an IBAT inhibitor, comprising administering to a mammal in need of such treatment or prevention a therapeutically effective amount of the formulation disclosed herein.
  • the invention relates to such a method for the treatment or prevention of diarrhoea wherein the liver disease is Alagilles syndrome (ALGS), progressive familial intrahepatic cholestasis (PFIC), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, cholestatic pruritus, non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).
  • AGS Alagilles syndrome
  • PFIC progressive familial intrahepatic cholestasis
  • PBC primary biliary cirrhosis
  • PSC primary sclerosing cholangitis
  • autoimmune hepatitis cholestatic pruritus
  • NAFLD non-alcoholic fatty liver disease
  • NASH non-alcoholic fatty liver disease
  • a liver disease as defined herein is any bile acid-dependent disease in the liver and in organs connected therewith, such as the pancreas, portal vein, the liver parenchyma, the intrahepatic biliary tree, the extrahepatic biliary tree, and the gall bladder.
  • Liver diseases include, but are not limited to an inherited metabolic disorder of the liver; inborn errors of bile acid synthesis; congenital bile duct anomalies; biliary atresia; neonatal hepatitis; neonatal cholestasis; hereditary forms of cholestasis; cerebrotendinous xanthomatosis; a secondary defect of BA synthesis; Zellweger ' s syndrome; cystic fibrosis (manifestations in the liver); alphal-antitrypsin deficiency; Alagilles syndrome (ALGS); Byler syndrome; a primary defect of bile acid (BA) synthesis; progressive familial intrahepatic cholestasis (PFIC) including PFIC-1, PFIC-2, PFIC-3 and non-specified PFIC; benign recurrent intrahepatic cholestasis (B IC) including BRIC1, BRIC2 and non-specified BRIC; autoimmune hepatitis; primary bil
  • disorders of fatty acid metabolism and glucose utilization disorders include, but are not limited to, hypercholesterolemia, dyslipidemia, metabolic syndrome, obesity, disorders of fatty acid
  • IBAT inhibitors are often referred to by different names.
  • IBAT inhibitors should be understood as also encompassing compounds known in the literature as Apical Sodium- dependent Bile Acid Transporter Inhibitors (ASBTI's), bile acid transporter (BAT) inhibitors, ileal sodium/bile acid cotransporter system inhibitors, apical sodium-bile acid cotransporter inhibitors, ileal sodium-dependent bile acid transport inhibitors, bile acid reabsorption inhibitors (BA I's), and sodium bile acid transporter (SBAT) inhibitors.
  • ASBTI's Apical Sodium- dependent Bile Acid Transporter Inhibitors
  • BAT bile acid transporter
  • ileal sodium/bile acid cotransporter system inhibitors ileal sodium/bile acid cotransporter system inhibitors
  • apical sodium-bile acid cotransporter inhibitors ileal sodium-dependent bile acid transport inhibitors
  • BA I's bile acid reabsorption inhibitors
  • IBAT inhibitors that can be used in combination with the bile acid sequestrant formulation disclosed herein include, but are not limited to, benzothiazepines, benzothiepines, 1,4-benzothiazepines, 1,5- benzothiazepines and 1,2,5-benzothiadiazepines.
  • Suitable examples of IBAT inhibitors that can be used in combination with the bile acid sequestrant formulation disclosed herein include, but are not limited to, the compounds disclosed in WO 93/16055, WO 94/18183, WO 94/18184, WO 96/05188, WO 96/08484, WO 96/16051, WO
  • IBAT inhibitors are those disclosed in WO 01/66533, WO 02/50051, WO
  • IBAT inhibitors are those disclosed in W099/32478, WO00/01687, WO01/68637, WO03/022804, WO 2008/058628 and WO 2008/058630, and especially the compounds selected from the group consisting of:
  • An effective amount of the cholestyramine formulation according to the invention can be any amount containing more than or equal to about 100 mg of cholestyramine, such as more than or equal to about 250 mg, 500 mg, 750 mg, 1000 mg, 1250 mg, 1500 mg, 1750 mg or 2000 mg of cholestyramine.
  • the effective amount of cholestyramine can be between 100 mg and 5000 mg, such as between 250 mg and 2500 mg, between 250 mg and 2000 mg, between 500 mg and 2500 mg, between 500 mg and 2000 mg, or between 750 mg and 2000 mg.
  • a unit dose of the cholestyramine formulation according to the invention may comprise from 200 to 300 mg of cholestyramine, such as from 220 to 280 mg of cholestyramine, such as from 240 to 260 mg of cholestyramine.
  • a unit dose preferably comprises about 250 mg of cholestyramine.
  • the daily dose can be administered as a single dose or divided into one, two, three or more unit doses.
  • the frequency of administration of the formulation as disclosed herein can be any frequency that reduces the bile acid malabsorption condition without causing any significant adverse effects or toxicity to the patient.
  • the frequency of administration can vary from once or twice a week to several times a day, such as once a day or twice a day.
  • the frequency of administration can furthermore remain constant or be variable during the duration of the treatment.
  • factors can influence the frequency of administration and the effective amount of the formulation that should be used for a particular application, such as the severity of the condition being treated, the duration of the treatment, as well as the age, weight, sex, diet and general medical condition of the patient being treated.
  • the invention is further illustrated by means of the following examples, which do not limit the invention in any respect. All cited documents and references are incorporated herein by reference. Abbreviations
  • the wet mass was transferred to an extruder equipped with a 1.5 mm screen, operated at 25 rpm (revolutions per minute) and the extrudate was collected on a stainless steel tray. Approximately 100 g of the extrudate was run in the spheronizer for 1 minute at a speed of 730 rpm. The spheronized material was then transferred to stainless steel trays, placed in a drying oven and dried for 16 hours at 50°C. The yield was calculated as the fraction of pellets that pass through a 1.6 mm sieve but are retained on a 1.0 mm sieve.
  • Pellets with a composition according to Table 1, entry 8 were manufactured at a batch size of 200 g in the extrusion step and 100 g in the spheronization step. 170 g cholestyramine, 15 g copovidone and 9 g microcrystalline cellulose were charged into a planetary mixer. The mixer was operated at intermediate speed and the liquid was slowly added in portions with mixing between each addition. First 300 g water with 20 g Eudragit ® RL 30 D (30% dry weight) was added in three equal portions, with mixing for 3 minutes between each addition. Finally 40 g pure water was added and mixing was performed for additionally 30 seconds. The wet mass was then transferred to the extruder.
  • the extruder was equipped with a 1.5 mm screen, operated at 25 rpm and the extrudate was collected on a stainless steel tray. Approximately 100 g of the extrudate was run in the spheronizer for 1 minute at a speed of 730 rpm. The spheronized material was then transferred to stainless steel trays, placed in a drying oven and dried for 16 hours at 50°C. The dried pellets were sieved and the fraction between 1 mm and 1.4 mm or between 1 mm and 1.6 mm was collected.
  • the cholestyramine pellets of Example 2 were formulated with a colon release coating based on Eudragit ® FS 30 D and native high amylose maize starch.
  • pellets composition for a unit dose comprising 250 mg cholestyramine is shown below. Amount
  • a glycerol monostearate (GMS) emulsion containing GMS, polysorbate 80 and triethyl citrate was prepared according to general instructions from Evonik.
  • the emulsion was then mixed with Eudragit ® FS 30 D (aqueous dispersion 30%).
  • the composition of the Eudragit FS 30 D coating dispersion, based on dry weight, is shown below. The concentration, based on dry weight, is 19.8% (w/w).
  • the pH of the dispersion was adjusted with a 0.3 M NaOH solution to 5.5.
  • the dispersion was mixed with a suspension of native starch granules containing 12.9% starch, 0.1% Kolliphor ® SLS fine and water.
  • the Eudragit ® dispersion was mixed with the starch suspension so that the ratio between polymer film and starch in the final film was 60% starch to 40% Eudragit ® FS 30 D film.
  • the composition of the coating, based on dry weight, is shown below.
  • the concentration, based on dry weight of the applied dispersion, is 15% (w/w). Amount
  • High amylose maize starch (Hylon ® VII) 59.7
  • Glycerol monostearate 45-55 (Kolliwax ® GMS II) 1.4
  • Polysorbate 80 (Tween ® 80) 0.6
  • the coating layer was applied using a Huttlin Kugelcoater HKC005.
  • the initial batch size was 75 g.
  • the coating process was performed with an air inlet temperature of 47-52°C, resulting in a product temperature of 27-29°C.
  • the air flow was adjusted to achieve an appropriate fluidization of the pellets during the coating.
  • the coating was applied to the cholestyramine pellets so as to obtain a weight gain of 84%
  • the coated pellets may be encapsulated in capsules, e.g. hard gelatine capsules. Details for the final formulations (on dry weight basis) are shown below:
  • the cholestyramine pellets of Example 2 were formulated with an inner barrier coating of hydroxylpropyl methylcellulose (HPMC), a colon release coating based on Eudragit ® FS 30 D and native high amylose maize starch and finally coated with fumed silica to prevent sticking of the pellets during storage.
  • HPMC hydroxylpropyl methylcellulose
  • Example 2 The cholestyramine pellets of Example 2 were formulated with an inner barrier coating of hydroxylpropyl methylcellulose (HPMC), a colon release coating based on Eudragit ® FS 30 D and native high amylose maize starch and finally coated with fumed silica to prevent sticking of the pellets during storage.
  • HPMC hydroxylpropyl methylcellulose
  • pellets composition for a unit dose comprising 250 mg cholestyramine is shown below.
  • a hydroxypropyl methylcellulose solution was prepared by suspending HPMC (Methocel E3, Colorcon) in hot water and then allowing the suspension to cool down so that the HPMC dissolved.
  • the concentration of HPMC in the solution was 10% (w/w).
  • the coating solution was applied using a Vector FL-M-1 apparatus. The initial batch size was 500 g.
  • the coating process was performed with an air inlet temperature of 57°C, resulting in a product temperature >40°C.
  • the air flow was adjusted to achieve an appropriate fluidization of the pellets during the coating.
  • the coating was applied to the cholestyramine pellets so as to obtain a weight gain of 3% (w/w). After the coating, the heating of the inlet air was switched off and the pellets were heat-treated in the coating equipment for 7 minutes.
  • a ready formulated mixture PlasACRYL ® T20 (aqueous dispersion 20%) containing glycerol monostearate (GMS), polysorbate 80 and triethylcitrat was mixed with Eudragit ® FS30D (aqueous dispersion 30%) and water according to general instructions from Evonik.
  • the composition of the Eudragit FS 30 D coating dispersion, based on dry weight, is shown below. The concentration, based on dry weight, is 20%. Amount
  • the pH of the dispersion was adjusted with a 0.3 M NaOH solution to 5.5.
  • the dispersion was mixed with a suspension of native starch granules containing 12.9% starch, 0.1% Kolliphor ® SLS fine and water.
  • the Eudragit ® dispersion was mixed with the starch suspension so that the ratio between polymer film and starch in the final film was 60% starch to 40% Eudragit ® FS 30 D film.
  • the composition of the coating, based on dry weight, is shown below. The concentration, based on dry weight of the applied dispersion, is 15% (w/w).
  • High amylose maize starch (Hylon ® VII) 59.7
  • the coating layer was applied using a Vector FL-M-1 apparatus.
  • the coating process was performed with an air inlet temperature of 39-40°C, resulting in a product temperature of 25-26°C.
  • the air flow was adjusted to achieve an appropriate fluidization of the pellets during the coating.
  • the coating was applied to the cholestyramine pellets so as to obtain a weight gain of 50% (w/w).
  • fumed silica was applied onto the coated pellets by spraying a 5% suspension of Aerosil ® 200 in water onto the pellets.
  • the coating was applied using the same equipment with an inlet temperature of 39-40°C, resulting in a product temperature of 30°C.
  • the air flow was adjusted to achieve an appropriate fluidization of the pellets during the coating.
  • the coating was applied to the cholestyramine pellets so as to obtain a weight gain of 1% (w/w).
  • the coated pellets were heat-treated at 40°C for 2 hours.
  • the coated pellets may be encapsulated in capsules, e.g. hard gelatine capsules. Details for the final formulations (on dry weight basis) are shown below:
  • the sequestering capacities of formulations A, B and C were determined in a simplified assay, simulating the pH of the stomach and the small intestine.
  • the sequestration was determined by measuring the decreasing amount of cholic acid in an aqueous solution.
  • the USP Dissolution Apparatus 2 (paddle) Ph. Eur. 2.9.3 was used.
  • the coated pellets of formulations A, B and C showed no or only minor disintegration at pH 5.5 or 6.8. Visual inspection of the pellets revealed that the coating was intact after stirring for 6 hours at pH 5.5 or after 2 hours at pH 1 followed by 4 hours at 6.8. In contrast, the uncoated pellets of
  • Example 2 when stirred in a phosphate buffer (50 m M, pH 6.8) at 300 rpm (propeller stirrer), fully disintegrated within 1 minute and 25 seconds.
  • the liquid medium for the proximal colon comprises a SH IM E ® matrix containing a stable microbial community representative for the human colon.
  • a method for obtaining a stable microbial community of the human intestine is described by Possemiers et al. (FEMS Microbiol. Ecol. 2004, vol. 49, p. 495-507) and references therein.
  • the sequestration was determined by measuring the decreasing amount of bile acids in an aqueous solution.
  • CA cholic acid
  • DUA deoxycholic acid
  • a comparative experiment was conducted to which pure cholestyramine powder was added.
  • a control experiment to which no cholestyramine was added was conducted in order to monitor the degradation of the bile salts under the colonic conditions used in the assay.
  • Amounts of formulations A, B and C corresponding to 91 mg of cholestyramine and the pure cholestyramine (91 mg) were dosed to 14 mL fasted stomach liquid medium (pH 1.8). The digests were incubated for 1 hour at 37 °C.
  • pancreatic juice pH 6.8 containing the defined 40:40:20 mixture of bile salts (46.7 mM) was added.
  • the small intestine digests were incubated for 2 hours at 37 °C and samples were taken after 0, 60 and 120 minutes.
  • the concentration of free bile salts in the samples was assessed by means of HPLC.
  • a calibration curve was used to calculate the concentrations of CA, CDCA and DCA in the samples.
  • One mL of each sample was centrifuged for 2 min at 5000 g. 500 ⁇ of the supernatant was mixed with 500 ⁇ of an 80:20 (v:v) mixture of methanol and phosphate buffer, vigorously vortexed, filtered through a 0.2 ⁇ PTFE filter and injected in a Hitachi Chromaster HPLC equipped with a UV-Vis detector.
  • the three bile salts were separated by a reversed-phase C18 column (Hydro-RP, 4 ⁇ , 80 A, 250 x 4.6 mm, Synergi).
  • the separation was performed under isocratic conditions at room temperature, using a 80:20 (v:v) mixture of methanol and phosphate buffer as the mobile phase.
  • the analysis was performed at 0.7 mL/min during 23 minutes and the bile salts were detected at 210 nm.
  • the injection volume was set at 20 ⁇ for stomach and small intestine samples and 50 ⁇ for colon samples.
  • the full SHIME ® matrix that was used for the colonic incubations contains (degraded) bile salts originating from BD DifcoTM Oxgall, a dehydrated fresh bile extract from bovine origin (Catalog Number 212820). Although the exact composition of this mixture is unknown, a higher quantity of free bile salts might be expected in the colon samples.
  • the values of the background i.e. blank sample where no mix of bile salts was added) were therefore subtracted from each sample in order to take into account the 'baseline' of free bile salts present in the total SHIM E
  • the table below shows the relative concentrations of CA, CDCA and DCA, respectively, after 2 hours of small intestinal incubations ("SI-2") and after 4 hours of colonic incubations ("C-4"), as well as the proportional reduction in the period therebetween.
  • the relative concentrations of CA, CDCA and DCA (%) vs. incubation time are shown in Figures 2, 3 and 4, respectively.
  • the graphs include the samples taken after 0 hours and 2 hours of small intestinal (SI) incubation, and after 0, 2, 4, 6, 19 and 24 hours of colonic (C) incubation.
  • the figures confirm the effect and extent of microbial salt metabolism in the gut (e.g. deconjugation, dehydrogenation and dehydroxylation) as observed by the significant decrease in bile salt levels in the control samples to which no cholestyramine was added. It can be seen that the three formulations offered a protection of the active compound during the small intestinal incubation. Whereas pure (uncoated) cholestyramine led to a reduction of 57% of CA, 91% of CDCA and 92% of DCA already after 2 hours of small intestinal incubation (see the comparative experiment), formulations A, B and C gave rise to much lower reduction of bile salts during this period.
  • microbial salt metabolism in the gut e.g. deconjugation, dehydrogenation and dehydroxylation
  • Hard capsules comprising formulation C (250 mg cholestyramine) were stored at 25 °C/60% H during 11 months.
  • the capsules were analysed for cholestyramine and water content. Also, the sequestering capacity of the formulation was determined using the assay described in Example 5. The results are shown in the table below.

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Abstract

L'invention concerne une formulation orale pour l'administration ciblée de cholestyramine au côlon comprenant une pluralité de pastilles de cholestyramine qui sont revêtues d'un revêtement de libération dans le côlon. L'invention concerne en outre l'utilisation de cette formulation dans le traitement de la malabsorption des acides biliaires.
EP17705974.8A 2016-02-09 2017-02-09 Formulation orale de cholestyramine et utilisation associée Active EP3413877B1 (fr)

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JP2019504886A (ja) 2019-02-21
CN108601744A (zh) 2018-09-28
WO2017138877A1 (fr) 2017-08-17
RU2750944C2 (ru) 2021-07-06
CA3011565C (fr) 2024-01-02
RU2018131288A (ru) 2020-03-11
CN108601744B (zh) 2022-01-04
ES2874669T3 (es) 2021-11-05
EP3413877B1 (fr) 2021-04-07

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